Healthcare Provider Details

I. General information

NPI: 1760434252
Provider Name (Legal Business Name): GARY MICHAEL GROSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BAPTIST MEDICAL CENTER SOUTH 2105 E. SOUTH BLVD
MONTGOMERY AL
36116
US

IV. Provider business mailing address

2905 MADREY LN SE
OWENS CROSS ROADS AL
35763-8465
US

V. Phone/Fax

Practice location:
  • Phone: 334-288-2100
  • Fax:
Mailing address:
  • Phone: 256-509-5869
  • Fax: 844-556-7447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD028899E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number57626
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: